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a�4.HIN. c SAN JOAQUIN COON' L -t\' <br /> ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-623 <br /> Telephone. (209 d6 - 22 Fax: - e ov.Orq/ehd <br /> 'uFak+ <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: w 1 �._( 2 ` m-}r , Date: <br /> ddress: 1aS9 I I �- S+ City: _ L." Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: 1l,32-2-, Program Record: 5 ( C� cl Inspection Type: <br /> Bt 80 Posted Yes No Permit Posted Yes No J Re-Inspection on or After: <br /> „ . OBSERVATIONS AND CORRECTIVE ACTIQI§ <br /> °� She • r . .., , 1 1��, ��� �.�� �- S •^-h- <br /> 1 Qo' F ( sgtceQ <br /> e l rvYr� <br /> t preQ 1-4a•./-� <br /> �a Le ner sv - c <br /> Cel� <br /> \2 1 w� ct <br /> 1 em/Location Temperature Item/Location <br /> Food Safety Certification " ' 'lity Hot Water Temperature Warewashing <br /> Name: Hand Sink: ..F Chlorine: ppm Heat eF <br /> Exp.Date: Warewashing Sink: `F Ouat. Amm.: ppmOther: of <br /> Received By/Title: <br /> EH specialist: Phone: '-1 b')-0 330 <br /> ime in: 2 N Time Out: 3 , 7� Pag of <br /> EHD 16-24 (2n°pg) 413113 �� FOOD PROGRAM OIR CONTINUATION <br />